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We aimed to describe the prevalence and prognostic importance of RAI in non\u2010critically ill patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review and meta\u2010analysis was performed using MeSH terms and Boolean operators to search five large databases (Ovid\u2010MEDLINE, ScienceDirect, Web of Science, Cochrane Library and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>). The population of interest was patients with cirrhosis and without critical illness. The primary outcome was the pooled prevalence of RAI as defined by a peak total cortisol level &lt;18\u2009\u03bcg\/dl, delta total cortisol &lt;9\u00a0\u03bcg\/dl or composite of the two thresholds in response either a standard\u2010dose or low\u2010dose short synacthen test. Odds ratios and standardized mean differences from random\u2010effects models estimated important clinical outcomes and patient characteristics by adrenal functional status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two studies were included in final analysis, comprising 1991 patients with cirrhosis. The pooled prevalence of RAI was 37% (95% CI 33\u201342%). The prevalence of RAI varied by Child\u2013Pugh classification, type of stimulation test used, specific diagnostic threshold and by severity of illness. Ninety\u2010day mortality was significantly higher in patients with RAI (OR 2.88, 95% CI 1.69\u20134.92, I2\u00a0=\u00a015%, p\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Relative adrenal insufficiency is highly prevalent in non\u2010critically ill patients with cirrhosis and associated with increased mortality. Despite the proposed multifactorial pathogenesis, no studies to date have investigated therapeutic interventions in this specific population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15473","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T13:32:26Z","timestamp":1668087146000},"page":"660-672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Relative adrenal insufficiency in the non\u2010critically ill patient with cirrhosis: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3642-887X","authenticated-orcid":false,"given":"Brian J.","family":"Wentworth","sequence":"first","affiliation":[{"name":"Division of Gastroenterology &amp; Hepatology, School of Medicine University of Virginia  Charlottesville Virginia 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